Clinical presentation and treatment of melioidosis in the head and neck region

Abstract

Background: Although melioidosis in the head and neck region is uncommon, it is a potentially life-threatening infection. Thus, early diagnosis and proper management are very important.

Objectives: To report the clinical presentation and management of melioidosis in the head and neck.

Method: A retrospective study was conducted from 1 January 2013 to 31 October 2016 in Mukdahan Hospital, Thailand. Case records of patients who had presented with culture-positive melioidosis were analysed.

Results: Medical records of 49 patients (23 males and 26 females) were analysed. Patients ranged in age from 1 to 75 years. Clinical presentations included 22 parotid abscesses, 16 neck abscesses and 11 suppurative lymphadenitis cases. Only 35 patients (71 per cent) had high indirect haemagglutination assay titres of ≥ 1:160 (95 per cent confidence interval = 45.35-88.28). Almost half of the patients received intravenous ceftazidime and subsequently oral co-trimoxazole. Oral antibiotic regimens were prescribed for mild localised melioidosis. Overall, 95.65 per cent of patients were in remission and no relapses were observed (95 per cent confidence interval = 85.47-98.80).

Conclusion: Careful clinical correlation and proper investigation are required to establish an early diagnosis of melioidosis and to initiate appropriate treatment.

Keywords: Burkholderia Pseudomallei; Lymphadenitis; Melioidosis; Parotitis.